Communal motivation in couples coping with vulvodynia: Sexual distress mediates associations with pain, depression, and anxiety

Using network analysis to model associations between psychological symptoms, sexual function, and sexual distress in women

Background

Psychological difficulties, including depression, anxiety, and somatization, are among the most important predictors for women's sexual function (i.e., arousal, desire, lubrication, pain, and satisfaction) and sexual distress. These associations have largely been studied at the construct level, with little research examining which specific symptoms might be most important for maintaining links between psychological difficulties and domains of sexual function. The present research sought to establish and characterize networks of women's psychological symptoms, sexual function, and sexual distress, and identify potential bridge symptoms that connect them.

Methods

In a cross-sectional study, 725 women reported on their sexual function, sexual distress, and depressive, anxiety, and somatization symptoms. A series of network analyses was used to identify central symptoms and connections between psychological symptoms, sexual function domains, and sexual distress.

Results

Across the modeled networks, sexual distress and pain during sex were consistent bridges between other sexual function domains and psychological symptoms.

Discussion

Overall, our models revealed sexual distress as an important potential mediator between sexual function problems and psychological symptoms that might contribute to the development and maintenance of comorbid sexual function and psychological problems.

Psychosocial Factors Associated With Vulvodynia

OBJECTIVES

We set out to identify the psychosocial factors associated with vulvodynia and the effects on sexuality, mental health, and quality of life.

MATERIALS AND METHODS

PubMed, LILACS, Embase, CINAHL, Web of Science, Scopus, and PsycINFO were searched in August 2023. Two authors selected and extracted the data independently. The risk of bias was assessed using the Newcastle-Ottawa Scale for Observational Studies. To rank the strength of evidence, the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) approach was utilized.

RESULTS

A total of 3,182 articles were identified. Twenty-two observational studies (8 cohorts and 14 case-controls) met the eligibility criteria and were included, comprising 2,624 patients. Vulvodynia has been associated with psychological factors (anxiety and depression) and social factors (childhood exposure to physical and sexual abuse, posttraumatic stress, and domestic abuse). Concerning sexual function, the most frequent outcomes were dyspareunia and sexual dysfunction. Only one study assessed quality of life, which showed that women with chronic vulvar pain had greater difficulty performing physical activities and experienced negative moods and feelings. The assessment of the risk of bias showed that the average quality of studies was good to excellent. However, the studies failed to select the nonexposed cohort or control group to describe the results, and often, the study population was rather small, which made it impossible to carry out a meta-analysis.

CONCLUSIONS

The certainty of evidence for the associations between anxiety and depression, vulvodynia, and sexual functioning suggests that combating these factors could improve overall quality of life in vulvodynia patients.

Intimacy Promotes Couples' Sexual Well-Being on a Daily Basis and Over One Year: The Role of Positive Sexual Cues

There is growing interest in identifying factors that promote sexual well-being in romantic relationships. One such factor is intimacy-a process involving self-disclosure and empathic response that is positively associated with sexuality outcomes. However, most work among community couples examined cross-sectional associations in mixed-sex/gender couples using a single sexual outcome, which may not capture daily variations in intimacy and different dimensions of sexual well-being among a diversity of unions over time. Additionally, potential mediating mechanisms of the intimacy-sexual well-being association, such as attention to positive sexual cues (i.e., sexual thoughts and feelings), have been neglected. Adopting daily diary and longitudinal designs, the present study examined whether greater intimacy was associated with higher levels of positive sexual cues and, in turn, higher sexual well-being (sexual desire, satisfaction and distress). A convenience sample of 211 couples (Mage = 30.2 years; SD = 8.3; 75 sexually diverse couples) completed a survey on days of sexual activity with their partner, over a 35-day period and 12 months later. Daily results showed that intimacy was related to greater attention to positive sexual cues for both partners, which in turn was associated with their greater sexual desire and satisfaction and lower sexual distress. Longitudinal results showed that a person's greater daily intimacy was linked to their own greater sexual desire and satisfaction 12 months later via their own higher positive sexual cues, but not to their partner's cues or well-being. Findings extend interpersonal models of sexual well-being and support the role of intimacy and positive sexual cues therein.

Motivation When Desire Is Low: Associations Between Sexual Motivation and Sexual Intimacy, Sexual Satisfaction, and Sexual Distress for Men with Hypoactive Sexual Desire Disorder and Their Partners

Hypoactive sexual desire disorder (HSDD) in men, characterized by chronically low sexual desire, is associated with poor sexual well-being, such as lower sexual satisfaction and higher sexual distress. Additionally, despite their low desire, men with HSDD often report wanting sexual intimacy and validation within their sexual lives/relationships. Studies that apply self-determination theory to sexual relationships demonstrate that adopting more autonomous (e.g., engaging in sex for its inherent pleasure) and less controlled (e.g., engaging in sex for some external reward or consequence) motives for engaging in sex is associated with greater sexual well-being for both members of the couple. Given that autonomous motivation in relationships is associated with intimacy and sexual satisfaction, and lower sexual distress, having sex for autonomous reasons may allow men with HSDD and their partners to feel more sexually intimate despite their lower sexual desire, whereas having sex for controlled reasons may hinder sexual intimacy and satisfaction and augment sexual distress. In this dyadic cross-sectional study, we examined the associations between types of sexual motivation and sexual intimacy, sexual satisfaction, and sexual distress for men with HSDD and their partners (n = 64 couples). Men with HSDD who reported having sex for more autonomous reasons reported more sexual satisfaction and both partners reported more sexual intimacy. Men with HSDD who had sex for more controlled reasons had partners who felt less sexual intimacy and satisfaction, and both partners were more sexually distressed. Promoting autonomous sexual motivation and decreasing controlled motivation may help couples navigating HSDD to feel closer in their relationship, more sexually satisfied, and less sexually distressed.

Responsiveness in the Face of Sexual Challenges: The Role of Sexual Growth and Destiny Beliefs

Implicit--or lay--sexual beliefs have been associated with how people respond to sexual challenges in romantic relationships. People who endorse sexual destiny beliefs view a satisfying sex life as the result of finding the right partner and report poorer sexual, relationship, and personal well-being when there are sexual challenges. In comparison, people who endorse sexual growth beliefs view satisfying sexual relationships as requiring hard work and effort to maintain and tend to report high sexual, relationship, and personal well-being even when facing sexual challenges. High sexual responsiveness - being motivated to meet a partner's sexual needs - is associated with maintaining high sexual satisfaction, even when couples face sexual challenges in a relationship. In the current research, we tested whether sexual growth and destiny beliefs are associated with general and sexual responsiveness and whether the associations are moderated by the presence of sexual challenges. Across three (clinical and non-clinical) samples (N = 820) facing different types of sexual challenges (Study 1 (Mage = 31.64, SD = 8.53), clinically low sexual desire; Studies 2 (Mage = 32.63, SD = 10.19) and 3 (Mage = 32.40, SD = 9.31), unmet sexual ideals; Study 3, changes in sex since the onset of the COVID-19 pandemic), we found that sexual growth beliefs were associated with higher sexual responsiveness and perceived partner sexual and general responsiveness, even when couples were coping with sexual challenges, whereas sexual destiny beliefs were not associated with responsiveness, and at times were associated with lower sexual responsiveness and perceived partner sexual and general responsiveness. This research provides initial evidence about how implicit sexual beliefs are associated with sexual and general responsiveness when couples are coping with sexual challenges in a romantic relationship.

The benefits (and costs) of sexual responsiveness in romantic relationships

Sex is one unique way people can show responsiveness in romantic relationships. Being and having a sexually responsive partner-who is understanding and motivated to make sexual compromises-is associated with sexual desire maintenance, sexual satisfaction, and relationship quality, especially when partners have different sexual interests or are coping with sexual issues. But, if being responsive to a partner's sexual needs involves self-neglect, sexual responsiveness no longer has these benefits and can be costly. Future research on sexual responsiveness should involve the development of a comprehensive measure incorporating lay perceptions and considering gendered sexual expectations, and an investigation of the balance between sexual autonomy and responsiveness in relationships.

Current Practices in Brazil on Diagnosis and Management of Women With Vulvodynia

OBJECTIVE

Vulvodynia (VVD) is a frequent and harrowing condition for which diagnosis and management remain insufficient. Our study aimed to describe and compare vulvovaginal signs and symptoms of Brazilian women with VVD and controls and describe previous medical assessment, past treatments, and vulvar pain relief among women with VVD.

METHODS

This cross-sectional descriptive study included Brazilian women with (n = 151) and without VVD (n = 106). All women were assessed for vaginal infection, vulvar pain intensity by means of a cotton swab test based on a numerical rate scale, and answered the Female Sexual Function Index questionnaire and a structured instrument about current vulvar symptoms. Previous treatments were assessed in the VVD group, and vulvar pain relief achieved with previous treatments was qualified through a 4-point Likert scale.

RESULTS

Volunteers were mainly White, with mean age of 30 years. Vulvovaginal signs and symptoms were significantly more frequent in women with VVD (p < .05), and vulvar pain duration was 5.8 (±4) years. More than 50% consulted with three or more physicians, and 49% remained without a conclusive diagnosis. Previous diagnosis and treatment of vulvovaginal infection were often reported by women with VVD. Most of the tried prescriptions were self-reported as providing only low vulvar pain relief.

CONCLUSIONS

Prolonged duration of vulvar pain, multiple visits to health care professionals, and poor relief of pain are common aspects in the clinical history of women with VVD. In addition to pain, vulvar fissure, edema, erythema, vaginal discharge, and foul odor are common and should be considered to avoid misdiagnosis. Appropriate treatments to VVD are still poorly reported.

What Does It Mean to Be Responsive to a Partner's Sexual Needs? Toward a Definition of Sexual Need Responsiveness

Being responsive to a partner's sexual needs in relationships (i.e., sexual need responsiveness) is associated with higher sexual and relationship satisfaction. Previous research has focused on researcher-led definitions of sexual need responsiveness. The purpose of the present study was to develop a participant-informed definition of sexual need responsiveness. A total of 305 individuals responded to five open-ended questions concerning the definition and behaviors pertaining to sexual need responsiveness. The content analysis results showed that the most common elements in participants' definition included listening to and accommodating each other's sexual needs and wishes whenever possible, while respecting both partners' safety and boundaries. Both verbal and non-verbal communication in various forms was used to express and share needs with partners and participants often evaluated responsiveness in terms of their sexual satisfaction. The results provide a participant-informed definition of sexual need responsiveness and can be used to inform research and clinical practice.

Comparing Self-Reported Pain During Intercourse and Pain During a Standardized Gynecological Exam at 12- and 24-Month Postpartum

BACKGROUND

There is limited information about the physical indicators and biopsychosocial predictors of self-reported pain during intercourse and pain during a gynecological examination at 12- and 24-month following childbirth.

AIM

This longitudinal study aimed to (i) Compare the findings from gynecological exams at 12- and 24-month postpartum for women with minimal vs clinically significant pain during intercourse; (ii) Assess the biomedical and psychosocial correlates of self-reported pain during intercourse and the vestibular pain index (VPI) from the cotton-swab test at 12- and 24-month postpartum; (iii) Establish the relationship between self-reported pain during intercourse and the cotton-swab test.

METHODS

Women (N = 97 at 12 months postpartum and N = 44 at 24-month postpartum) recruited from a local women's hospital completed online surveys in their first trimester of pregnancy and at 12- and 24-month postpartum to assess pain during intercourse and biopsychosocial variables. Those with clinically significant (pain ≥4/10 on a visual analogue scale) were matched with those reporting minimal pain (pain <3/10) and underwent a gynecological exam including a cotton-swab test. Descriptive analyses, multiple regressions, and bivariate correlations were conducted to address each of the study aims, respectively.

MAIN OUTCOME MEASURES

(i) Findings from the gynecological examination (ii) Numerical rating scale for the VPI; (iii) Visual analogue scale of pain during intercourse.

RESULTS

The majority of women in both pain groups had normal physical findings in the gynecological exam. Greater sexual distress and pain catastrophizing at 12- and 24-month postpartum were significantly associated with greater pain during intercourse at each time-point, respectively. Greater pain catastrophizing at 12 months postpartum was significantly associated with greater pain during the cotton-swab test at that time-point. Lower relationship satisfaction at 12 months postpartum was associated with greater VPI ratings at 24 months postpartum. Pain during intercourse and the VPI were moderately and positively correlated.

CLINICAL IMPLICATIONS

Addressing psychosocial variables may interrupt the maintenance of postpartum pain. Following an initial assessment, self-reported pain intensity may be a suitable proxy for repeated examinations.

STRENGTHS & LIMITATIONS

This study is the first to describe the physical findings and psychosocial predictors of pain during intercourse and the VPI at 12- and 24-month postpartum. The homogenous and small sample may limit generalizability.

CONCLUSION

There were no observable physical indicators of clinically significant postpartum pain during intercourse. Psychosocial variables were linked to women's greater postpartum pain during intercourse and VPI ratings.

Discrepancy in Dyadic Sexual Desire Predicts Sexual Distress over Time in a Community Sample of Committed Couples: A Daily Diary and Longitudinal Study

In long-term relationships, sexual desire discrepancy (SDD) occurs frequently between partners. For many, this discrepancy is persistent and significant, and a source of distress. However, the dynamics of SDD in couples and, specifically, its implications for sexual distress have received scant empirical attention. This study examined the associations between SDD and sexual distress from one day to the next and over a 12-month span, in a community sample of 229 same-sex/gender and mixed-sex/gender couples. Two datasets were collected: A 35-day daily diary and a 12-month longitudinal survey. In both, dyadic sexual desire and sexual distress were measured, and SDD was calculated as the absolute value of the difference in sexual desire between partners. Directional associations between SDD at one time point and sexual distress at the next time point were assessed using multilevel, 2-pane autoregressive cross-lagged models, controlling for within-variable changes, dependencies between partners, and partner age. Results were consistent with the study's hypotheses: Couples' SDD on one day predicted sexual distress on the next day. Similarly, SDD at baseline predicted sexual distress 12 months later. Participant gender, partner gender, and couple type did not significantly moderate these associations, nor did differentiating partners based on higher and lower average sexual desire. The reverse associations (i.e., sexual distress predicting SDD) were non-significant. The associations' directionality and the fact that they remained significant over days and months were consistent with the proposal that SDD is a precursor of sexual distress. The present study provides support for dyadic conceptualizations of sexual desire. Clinically, findings suggest that therapeutic approaches should address issues with sexual desire and sexual distress by focusing not on the individual, but on the couple.

Pornography Use and Sexual Health among Same-Sex and Mixed-Sex Couples: An Event-Level Dyadic Analysis

A large number of partnered individuals regularly use or are in a relationship with someone who uses pornography. However, knowledge concerning the association between pornography use and partnered sexual health-sexual satisfaction, distress, and function-is fragmentary. The current study used an event-level dyadic design to examine the associations between pornography use and sexual satisfaction, distress, and function on days when partnered sexual activity occurred. A convenience sample of 217 couples (M_age = 30.2; SD = 8.3; 72 same-sex couples) completed a short survey on days of sexual activity with their partner, over a 35-day period. Self-report measures included questions about daily pornography use and masturbation as well as daily sexual satisfaction, distress, and function. Using pornography on days of partnered sexual activity was reported by half of the couples. An individual's solitary pornography use on days of partnered sexual activity was related to their partner's higher sexual distress and, for women's use only, to their own higher quality of lubrication, compared to sex days without solitary pornography use. There was no evidence of an association between pornography use on sex days, whether alone or with the partner, and all other aspects of sexual health including sexual satisfaction. Our findings capture the complexity of the associations between pornography and sexual health. Men and women's pornography use may create idealized fantasies around appearance and performance, which may lead the partner to feel distressed about their sex life. Women's pornography use might facilitate their sexual responsiveness during partnered sexual activity.

Avoidantly Attached Individuals Are More Exchange-Oriented and Less Communal in the Bedroom

Sexual need fulfillment in a relationship is associated with both partners' sexual and relationship quality. In the current research, we explored what underlies two approaches to sexual need fulfillment-sexual communal norms (i.e., being motivated to meet a partner's sexual needs) and sexual exchange norms (i.e., tracking and trading sexual benefits). People high in attachment avoidance are less responsive to their partner's needs and distance themselves from intimacy. Sexuality is a domain in which partners aim to meet each other's needs, but it may also heighten avoidantly attached partners' concerns about intimacy. Across three studies (N = 711)-using cross-sectional, dyadic, daily experience, and longitudinal methods-endorsing sexual communal norms was associated with greater sexual and relationship quality, whereas endorsing sexual exchange norms was not associated with, or was linked to lower, sexual and relationship quality. People who were higher (compared to lower) in attachment avoidance were less sexually communal and more exchange-oriented, and their heightened endorsement of sexual exchange norms predicted lower relationship satisfaction over time. With two exceptions, the effects were largely consistent for men versus women. Findings from this research suggest that attachment avoidance underlies approaches to sexual need fulfillment in relationships.

Psychosocial factors associated with pain and sexual function in women with Vulvodynia: A systematic review

Background and objective

Vulvodynia is a prevalent chronic vulval pain condition affecting 10%–28% of women, and significantly impacting their health and quality of life. It is currently poorly understood and biomedical treatments achieve only modest benefits for pain and sexual functioning. A wider psychosocial conceptualization of this condition may improve outcomes. There is currently no coherent understanding of how psychosocial factors may contribute to outcomes in Vulvodynia. The aim of this review is to identify and systematically review psychosocial factors associated with pain and sexual outcomes and to inform a psychosocial model of Vulvodynia.

Databases and data treatment

Observational/experimental studies reporting on the association between psychosocial factors and pain/sexual outcomes in adult women with Vulvodynia were eligible. Two reviewers independently conducted eligibility screening, data extraction and quality assessment. Twenty‐one studies were included, all focused on women with Provoked Vestibulodynia (PVD). Most of the studies were low‐to‐medium quality.

Results/Conclusion

A range of general/pain‐related distress and avoidance processes, and sex/intimacy avoidance or engagement processes were significantly associated with pain, sexual functioning or sexual distress and sexual satisfaction, supporting the role of a psychosocial approach to PVD. Depression, anxiety, catastrophizing, pain‐anxiety, pain acceptance, body‐exposure anxiety, attention to sexual cues, partner hostility and solicitousness, self‐efficacy and penetration cognitions are highlighted as potentially important treatment targets in PVD. Due to the limited data available, developing a psychosocial model was not possible. Directions for future research include examining the replicability and generalizability of the factors identified, exploring differences/similarities across Vulvodynia subsets and testing tailored theoretically based treatments.

Significance

The systematic review highlights the role of psychosocial factors associated with pain and sexual functioning in Vulvodynia. The review findings reveal that Vulvodynia presents both similar and unique cognitive, behavioural and interpersonal features compared to other chronic pain conditions. There may be important roles for negative sexual cues, body image–related factors during intercourse, partner factors, self‐efficacy beliefs and penetration cognitions, in relation to pain and sexual functioning.

Efficiency and Cost: E-Recruitment Is a Promising Method in Gynecological Trials

BACKGROUND

Recruitment of participants is crucial to the success of any trial as it can have a major impact on study costs, the duration of the study itself, and, more critically, trial failure. Given that vulvodynia particularly affects young women, the use of social media and e-recruitment could prove efficient for enrollment.

AIM

To compare the efficiency, effectiveness, and cost-effectiveness of three different recruitment methods.

METHODS

The comparison data were collected as part of a bicentric randomized controlled trial evaluating the efficacy of physiotherapy in comparison with topical lidocaine in 212 women suffering from provoked vestibulodynia. The recruitment methods included: (i) conventional methods (eg, posters, leaflets, business cards, newspaper ads); (ii) health professional referrals, and (iii) e-recruitment (eg, Facebook ads and web initiatives). Women interested in participating were screened by telephone for eligibility criteria and were assessed by a gynecologist to confirm their diagnosis. Once included, structured interviews were undertaken to describe their baseline characteristics.

MAIN OUTCOME MEASURES

The outcomes of this study were the recruitment efficiency (the number of patients screened/enrolled), recruitment effectiveness (the number of participants enrolled), cost-effectiveness (cost per enrolled participant), and retention rate, and baseline characteristics of participants were monitored for each method.

RESULTS

The conventional methods (n = 101, 48%) were more effective as they allowed for greater enrollment of participants, followed by e-recruitment (n = 60, 28%) and health professional referrals (n = 33, 16%) (P < 0.007). Recruitment efficiency was found to be similar for e-recruitment and referrals (60/122 and 33/67, 49%, P = 0.055) but lower for conventional methods (101/314, 32%, P < 0.011). Nonsignificant differences were found between the three groups for baseline characteristics (P ≥ 0.189) and retention rate (91%, P ≥ 0.588). The average cost per enrolled participant was fairly similar for e-recruitment ($117) and conventional methods ($110) and lower for referrals ($60).

CLINICAL IMPLICATIONS

Our results suggest that having a variety of recruitment methods is beneficial in promoting clinical trial recruitment without affecting participant characteristics and retention rates.

STRENGTH & LIMITATIONS

Although recruitment methods were used concomitantly, this study gives an excellent insight into the advantages and limitations of recruitment methods owing to a large sample size.

CONCLUSION

The study findings revealed that e-recruitment is a valuable recruitment method because of its comparable efficiency and cost-effectiveness to health professional referrals and conventional methods, respectively.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, number NCT01455350. Benoit-Piau J, Dumoulin C, Carroll MS, et al. Efficiency and Cost: E-Recruitment Is a Promising Method in Gynecological Trials. J Sex Med 2020;17:1304-1311.

Sexual communal motivation in couples coping with low sexual interest/arousal: Associations with sexual well-being and sexual goals

Women coping with female sexual interest/arousal disorder (FSIAD) report lower sexual and relationship satisfaction compared to healthy controls. In community samples, high sexual communal strength (i.e., the motivation to meet a partner's sexual needs) is associated with higher sexual desire and satisfaction, but high unmitigated sexual communion (i.e., the prioritization of a partner's needs to the exclusion of one's own needs) is associated with lower sexual satisfaction. People higher in sexual communal strength report engaging in sex for approach goals (i.e., to enhance intimacy in their relationship), but not for avoidance goals (i.e., to avert conflict or a partner's disappointment) and this is one reason why they report greater sexual desire. In the current sample of 97 women diagnosed with FSIAD and their partners we investigated the association between sexual communal strength and unmitigated sexual communion and sexual well-being (i.e., sexual desire, sexual satisfaction and sexual distress) and sexual goals (i.e., approach and avoidance goals). Women who reported higher sexual communal strength were more likely to pursue sex for approach goals and their partner reported greater sexual satisfaction. When partners reported higher sexual communal strength, they reported higher sexual desire, but when they reported higher unmitigated sexual communion, they reported higher sexual distress. Additional associations emerged for couples who engage in sex more (compared to less) frequently. Our findings demonstrate that being motivated to meet a partner's sexual needs is associated with greater sexual well-being for couples coping with FSIAD, but when this motivation involves neglecting one's own needs, people do not report greater sexual well-being and instead, partners report higher sexual distress.

Sexual Motivation in Couples Coping with Female Sexual Interest/Arousal Disorder: A Comparison with Control Couples

A lack of interest in sex is a common sexual issue, especially among women, and can be associated with lower relationship satisfaction and greater psychological distress. Research on sexual motivation has demonstrated that, in both community and clinical samples, people higher in sexual communal strength (motivated to meet their partner's sexual needs) and approach sexual goals (motivated to engage in sex to pursue positive outcomes) report higher desire and relationship satisfaction; whereas people higher in avoidance sexual goals (motivated to engage in sex to avert negative outcomes) tend to report lower desire and satisfaction. In the current study, we compared the sexual motivation of women diagnosed with female sexual interest/arousal disorder (FSIAD), who report chronic low desire and arousal accompanied by distress, and their partners (N = 97 couples) with couples without a sexual dysfunction (N = 108 couples). Women with FSIAD reported lower sexual communal strength and approach goals and higher avoidance sexual goals compared with control women and their own partners. However, the partners of women with FSIAD did not report differences in sexual motivation compared with control partners. Sexual motivation may be a target for future intervention studies with couples coping with low desire and arousal.

Genito-Pelvic Pain Through a Dyadic Lens: Moving Toward an Interpersonal Emotion Regulation Model of Women's Sexual Dysfunction

Researchers and clinicians alike widely acknowledge the inherently interpersonal nature of women's sexual dysfunctions given that both partners impact and are impacted by these difficulties. Yet theoretical models for understanding the role of interpersonal factors in women's sexual dysfunctions are severely lacking and have the potential to guide future research and inform more effective interventions. The most widely studied sexual dysfunction in women that has espoused a dyadic approach by including both members of affected couples is genito-pelvic pain/penetration disorder (GPPPD). In this article we use the example of GPPPD to introduce a novel interpersonal emotion regulation model of women's sexual dysfunction. We first review current knowledge regarding distal and proximal interpersonal factors in GPPPD. Then, we describe our theoretical model and consider relevant pain and sex-related research on emotion regulation processes-emotional awareness, expression, and experience-in the context of GPPPD, including sexual function, satisfaction, and distress. Next, we review how existing theories from the fields of chronic pain and sex and relationships research have informed our model and how our model further builds on them. Finally, we discuss the implications of our model and its applications, including to other sexual dysfunctions in women.

Sexual Distress Mediates the Associations Between Sexual Contingent Self-Worth and Well-Being in Women With Genitopelvic Pain: A Dyadic Daily Experience Study

Provoked vestibulodynia (PVD), a common cause of women's genitopelvic pain, is associated with poorer psychological and sexual well-being in affected couples. Greater sexual contingent self-worth (CSW)-defined as self-esteem that is dependent on the perceived success or failure of a sexual relationship-has been linked to poorer well-being in a cross-sectional study of couples coping with PVD. This study aimed to examine whether daily sexual distress mediated the associations between greater sexual CSW and lower sexual satisfaction and greater anxiety, depressed mood, and women's pain in affected couples. Women (N = 125) diagnosed with PVD and their partners completed the Sexual CSW Scale and then online daily surveys for eight weeks measuring sexual distress, sexual satisfaction, anxiety, depressed mood, and women's pain during intercourse. Multilevel analyses were based on the actor-partner interdependence model (APIM). For women who had higher sexual CSW (compared to lower sexual CSW), on sexual activity days when their sexual distress was higher, they reported lower sexual satisfaction and greater anxiety, depressed mood, and pain (compared to their average level across all sexual activity days). Findings suggest that daily sexual distress may be one pathway between greater sexual CSW and poorer day-to-day well-being in women with PVD.